Medical investigations are a routine component of all health check protocols.
“Whole body tests are just a means and not an end to the road to good health.”
Care and concern for one’s own health is great and should be encouraged across all strata of society. Most evidence-based guidelines now recommend health checks, and they are an important component of a desire to stay healthy.
Medical investigations are a routine component of all health check protocols. There has been an immense surge in their popularity among urban Indians, further fuelled by the post-pandemic fear and concern for one’s own health. Many of these tests and packages are now self-prescribed and patients often consult a doctor only after these tests have already been performed. In many cases, even their reports are self-interpreted, after the abnormalities have been highlighted by the artificial intelligence of the laboratory software.
I was in a busy cardiology OPD recently when two patients consulted me one after the other. They had a completely contrasting views and attitudes about the role of investigations in preventive clinical practice. This made me wonder if one could ever devise a comprehensive list of investigations which would be applicable during preventive health checks in all patients.
Case 1 – Mr Ram Bahadur (name changed) 60 years old obese, diabetic, presented with recent onset breathlessness. Based on his clinical background, I advised him a few general blood and urine tests, along with some specific tests to evaluate for the status of his heart and lungs. The patient’s first response on reading the prescription was to question the appropriateness of investigations and enquire whether he was being over-investigated?
Case 2 – Mr Karan (name changed) aged 25 years consulted me immediately after the previous case for getting a “whole-body checkup”. He had no symptoms and is in good health. When I asked about the reason for his keenness for a health checkup at such a young age, he mentioned that he had recently lost his father, unexpectedly – that too a few days after visiting his family physician. He felt that his father could’ve been investigated in greater detail – in order to prevent this unanticipated misfortune.
So what’s ideal – too many or too few?
To understand the role of preventive health investigations – we need to get the right perspective. While medical investigations play an important part in early diagnosis and preventing disease, they are not the only component of staying healthy and living long. Other measures such as a good diet, regular exercise, adequate sleep and abstinence from substances of abuse play an equally important role in good health.
Health of a person is often determined by a fine balance of nature and nurture. Investigations need to be ordered, based on background factors such as family history, risk profile and previous disease as well as presenting symptoms of a patient. An important additional factor determining the thoroughness of evaluation in an individual is his job profile. Those in high intensity jobs such as armed forces or flying, obviously need a more thorough evaluation. This principle – even in the contemporary era of liberal availability of investigations – remains the guiding principle of clinical medical practice.
“WHOLE -BODY TEST” IS A STARTING POINT – NOT THE END POINT
A commonly encountered phrase in recent times is a “whole body test”. A human body is a highly complex machine consisting of more than 35 trillion cells organised into multiple organ systems– each beautifully and accurately controlled by hormones, chemical, genetic as well as external influences. The body is so complex that calling it a machine trivializes the complexity of a human being. An abnormality in any of these can trigger disease. To expect that the health of all these components can be predicted by a few blood and urine tests is akin to predicting the results of a national election with a sample size of a few individuals. The currently included tests in a “whole body test” protocol can, at best, only serve as beacon of direction to look for specific diseases. To that extent, they form an important baseline from where one goes ahead.
INVESTIGATION REPORTS ARE DYNAMIC
Dynamism is yet another variable in the process of predicting disease. Human body is ever changing. What’s applicable and relevant today, may be meaningless in a few months. The same applies to medical investigations. The validity of investigations is time bound. Hence the reports of these tests may become irrelevant after a few months to a year – depending on which test one is referring to. A periodicity, therefore, needs to be followed in case one wishes to derive meaningful conclusions from the tests. Additionally, observing trends in a report is far more important than a solitary reading. A single time test protocol is not expected to assure health or predict disease for one’s entire life.
Medical tests serve an important purpose of conveying the current status of one’s health. When a series of tests is performed, it is a scientific way to predict the health of specific organs. The statistical chance of harbouring disease in that organ with a normal report is low. But the risk is not zero. In a few cases, disease can occur despite normal reports.
ONE MUST ACT ON THE REPORTS
Medical investigation results provide us with valuable information about what needs to be done. To that extent they are a means and not an end to evaluation. A test report will culminate in good health only if one acts on the abnormal variables – either by lifestyle modification or by getting treated for it. It serves no purpose to gather information and not take remedial action.
Medical investigations are an important component of any healthcare strategy. The idea of this writing is not to discourage one from getting tested. In fact, the aim is completely contrary. When medical investigations are done, it’s important to have the right expectations without over relying on them as being the only road to good health or downplaying their importance. While investigations serve an important predictive role of an individual’s health status, disease can rarely occur outside the realms of statistical forecasts. A regularity needs to be followed while getting health checks and most importantly, one must act on abnormal reports and aberrations. Only then will medical investigations contribute to better health and longevity.
Prof Hemant Madan is an Interventional Cardiologist and Programme Head, Cardiac Sciences for Narayana Health.